Project Imaging-X: A Survey of 1000+ Open-Access Medical Imaging Datasets for Foundation Model Development

Foundation models have demonstrated remarkable success across diverse domains and tasks, primarily due to the thrive of large-scale, diverse, and high-quality datasets. However, in the field of medical imaging, the curation and assembling of such medical datasets are highly challenging due to the reliance on clinical expertise and strict ethical and privacy constraints, resulting in a scarcity of large-scale unified medical datasets and hindering the development of powerful medical foundation models. In this work, we present the largest survey to date of medical image datasets, covering over 1,000 open-access datasets with a systematic catalog of their modalities, tasks, anatomies, annotations, limitations, and potential for integration. Our analysis exposes a landscape that is modest in scale, fragmented across narrowly scoped tasks, and unevenly distributed across organs and modalities, which in turn limits the utility of existing medical image datasets for developing versatile and robust medical foundation models. To turn fragmentation into scale, we propose a metadata-driven fusion paradigm (MDFP) that integrates public datasets with shared modalities or tasks, thereby transforming multiple small data silos into larger, more coherent resources. Building on MDFP, we release an interactive discovery portal that enables end-to-end, automated medical image dataset integration, and compile all surveyed datasets into a unified, structured table that clearly summarizes their key characteristics and provides reference links, offering the community an accessible and comprehensive repository. By charting the current terrain and offering a principled path to dataset consolidation, our survey provides a practical roadmap for scaling medical imaging corpora, supporting faster data discovery, more principled dataset creation, and more capable medical foundation models.

Uncertainty Quantification for Distribution-to-Distribution Flow Matching in Scientific Imaging

Distribution-to-distribution generative models support scientific imaging tasks ranging from modeling cellular perturbation responses to translating medical images across conditions. Trustworthy generation requires both reliability (generalization across labs, devices, and experimental conditions) and accountability (detecting out-of-distribution cases where predictions may be unreliable). Uncertainty quantification (UQ) based approaches serve as promising candidates for these tasks, yet UQ for distribution-to-distribution generative models remains underexplored. We present a unified UQ framework, Bayesian Stochastic Flow Matching (BSFM), that disentangles aleatoric and epistemic uncertainty. The Stochastic Flow Matching (SFM) component augments deterministic flows with a diffusion term to improve model generalization to unseen scenarios. For UQ, we develop a scalable Bayesian approach -- MCD-Antithetic -- that combines Monte Carlo Dropout with sample-efficient antithetic sampling to produce effective anomaly scores for out-of-distribution detection. Experiments on cellular imaging (BBBC021, JUMP) and brain fMRI (Theory of Mind) across diverse scenarios show that SFM improves reliability while MCD-Antithetic enhances accountability.

CellFluxRL: Biologically-Constrained Virtual Cell Modeling via Reinforcement Learning

Building virtual cells with generative models to simulate cellular behavior in silico is emerging as a promising paradigm for accelerating drug discovery. However, prior image-based generative approaches can produce implausible cell images that violate basic physical and biological constraints. To address this, we propose to post-train virtual cell models with reinforcement learning (RL), leveraging biologically meaningful evaluators as reward functions. We design seven rewards spanning three categories-biological function, structural validity, and morphological correctness-and optimize the state-of-the-art CellFlux model to yield CellFluxRL. CellFluxRL consistently improves over CellFlux across all rewards, with further performance boosts from test-time scaling. Overall, our results present a virtual cell modeling framework that enforces physically-based constraints through RL, advancing beyond "visually realistic" generations towards "biologically meaningful" ones.

Fine-tuning MLLMs Without Forgetting Is Easier Than You Think

The paper demonstrate that simple adjustments of the fine-tuning recipes of multimodal large language models (MLLM) are sufficient to mitigate catastrophic forgetting. On visual question answering, we design a 2x2 experimental framework to assess model performance across in-distribution and out-of-distribution image and text inputs. Our results show that appropriate regularization, such as constraining the number of trainable parameters or adopting a low learning rate, effectively prevents forgetting when dealing with out-of-distribution images. However, we uncover a distinct form of forgetting in settings with in-distribution images and out-of-distribution text. We attribute this forgetting as task-specific overfitting and address this issue by introducing a data-hybrid training strategy that combines datasets and tasks. Finally, we demonstrate that this approach naturally extends to continual learning, outperforming existing methods with complex auxiliary mechanisms. In general, our findings challenge the prevailing assumptions by highlighting the inherent robustness of MLLMs and providing practical guidelines for adapting them while preserving their general capabilities.

Tool Verification for Test-Time Reinforcement Learning

Test-time reinforcement learning (TTRL) has emerged as a promising paradigm for self-evolving large reasoning models (LRMs), enabling online adaptation on unlabeled test inputs via self-induced rewards through majority voting. However, a spurious yet high-frequency unverified consensus can become a biased and reinforced reward signal, leading to incorrect mode collapse. We address this failure mode with T^3RL (Tool-Verification for Test-Time Reinforcement Learning), which introduces test-time tool verification into reward estimation. Concretely, a verifier uses an external tool as evidence (e.g., from code execution) to upweight verified rollouts in a verification-aware voting, producing more reliable pseudo-labels for training. Across various math difficulties (MATH-500, AMC, and AIME 2024) and diverse backbone types, T^3RL significantly improves over TTRL, with larger gains on harder problems. More broadly, T^3RL can be viewed as verified online data synthesis, highlighting test-time tool verification as a key mechanism for stabilizing self-evolution.

UniT: Unified Multimodal Chain-of-Thought Test-time Scaling

Unified models can handle both multimodal understanding and generation within a single architecture, yet they typically operate in a single pass without iteratively refining their outputs. Many multimodal tasks, especially those involving complex spatial compositions, multiple interacting objects, or evolving instructions, require decomposing instructions, verifying intermediate results, and making iterative corrections. While test-time scaling (TTS) has demonstrated that allocating additional inference compute for iterative reasoning substantially improves language model performance, extending this paradigm to unified multimodal models remains an open challenge. We introduce UniT, a framework for multimodal chain-of-thought test-time scaling that enables a single unified model to reason, verify, and refine across multiple rounds. UniT combines agentic data synthesis, unified model training, and flexible test-time inference to elicit cognitive behaviors including verification, subgoal decomposition, and content memory. Our key findings are: (1) unified models trained on short reasoning trajectories generalize to longer inference chains at test time; (2) sequential chain-of-thought reasoning provides a more scalable and compute-efficient TTS strategy than parallel sampling; (3) training on generation and editing trajectories improves out-of-distribution visual reasoning. These results establish multimodal test-time scaling as an effective paradigm for advancing both generation and understanding in unified models.

ArtifactLens: Hundreds of Labels Are Enough for Artifact Detection with VLMs

Modern image generators produce strikingly realistic images, where only artifacts like distorted hands or warped objects reveal their synthetic origin. Detecting these artifacts is essential: without detection, we cannot benchmark generators or train reward models to improve them. Current detectors fine-tune VLMs on tens of thousands of labeled images, but this is expensive to repeat whenever generators evolve or new artifact types emerge. We show that pretrained VLMs already encode the knowledge needed to detect artifacts - with the right scaffolding, this capability can be unlocked using only a few hundred labeled examples per artifact category. Our system, ArtifactLens, achieves state-of-the-art on five human artifact benchmarks (the first evaluation across multiple datasets) while requiring orders of magnitude less labeled data. The scaffolding consists of a multi-component architecture with in-context learning and text instruction optimization, with novel improvements to each. Our methods generalize to other artifact types - object morphology, animal anatomy, and entity interactions - and to the distinct task of AIGC detection.

iSight: Towards expert-AI co-assessment for improved immunohistochemistry staining interpretation

Immunohistochemistry (IHC) provides information on protein expression in tissue sections and is commonly used to support pathology diagnosis and disease triage. While AI models for H\&E-stained slides show promise, their applicability to IHC is limited due to domain-specific variations. Here we introduce HPA10M, a dataset that contains 10,495,672 IHC images from the Human Protein Atlas with comprehensive metadata included, and encompasses 45 normal tissue types and 20 major cancer types. Based on HPA10M, we trained iSight, a multi-task learning framework for automated IHC staining assessment. iSight combines visual features from whole-slide images with tissue metadata through a token-level attention mechanism, simultaneously predicting staining intensity, location, quantity, tissue type, and malignancy status. On held-out data, iSight achieved 85.5\% accuracy for location, 76.6\% for intensity, and 75.7\% for quantity, outperforming fine-tuned foundation models (PLIP, CONCH) by 2.5--10.2\%. In addition, iSight demonstrates well-calibrated predictions with expected calibration errors of 0.0150-0.0408. Furthermore, in a user study with eight pathologists evaluating 200 images from two datasets, iSight outperformed initial pathologist assessments on the held-out HPA dataset (79\% vs 68\% for location, 70\% vs 57\% for intensity, 68\% vs 52\% for quantity). Inter-pathologist agreement also improved after AI assistance in both held-out HPA (Cohen's $κ$ increased from 0.63 to 0.70) and Stanford TMAD datasets (from 0.74 to 0.76), suggesting expert--AI co-assessment can improve IHC interpretation. This work establishes a foundation for AI systems that can improve IHC diagnostic accuracy and highlights the potential for integrating iSight into clinical workflows to enhance the consistency and reliability of IHC assessment.

Seeing Is Believing? A Benchmark for Multimodal Large Language Models on Visual Illusions and Anomalies

Multimodal Large Language Models (MLLMs) have shown remarkable proficiency on general-purpose vision-language benchmarks, reaching or even exceeding human-level performance. However, these evaluations typically rely on standard in-distribution data, leaving the robustness of MLLMs largely unexamined when faced with scenarios that defy common-sense priors. To address this gap, we introduce VIA-Bench, a challenging benchmark designed to probe model performance on visual illusions and anomalies. It includes six core categories: color illusions, motion illusions, gestalt illusions, geometric and spatial illusions, general visual illusions, and visual anomalies. Through careful human-in-the-loop review, we construct over 1K high-quality question-answer pairs that require nuanced visual reasoning. Extensive evaluation of over 20 state-of-the-art MLLMs, including proprietary, open-source, and reasoning-enhanced models, uncovers significant vulnerabilities. Notably, we find that Chain-of-Thought (CoT) reasoning offers negligible robustness, often yielding ``brittle mirages'' where the model's logic collapses under illusory stimuli. Our findings reveal a fundamental divergence between machine and human perception, suggesting that resolving such perceptual bottlenecks is critical for the advancement of artificial general intelligence. The benchmark data and code will be released.

Do VLMs Perceive or Recall? Probing Visual Perception vs. Memory with Classic Visual Illusions

Large Vision-Language Models (VLMs) often answer classic visual illusions "correctly" on original images, yet persist with the same responses when illusion factors are inverted, even though the visual change is obvious to humans. This raises a fundamental question: do VLMs perceive visual changes or merely recall memorized patterns? While several studies have noted this phenomenon, the underlying causes remain unclear. To move from observations to systematic understanding, this paper introduces VI-Probe, a controllable visual-illusion framework with graded perturbations and matched visual controls (without illusion inducer) that disentangles visually grounded perception from language-driven recall. Unlike prior work that focuses on averaged accuracy, we measure stability and sensitivity using Polarity-Flip Consistency, Template Fixation Index, and an illusion multiplier normalized against matched controls. Experiments across different families reveal that response persistence arises from heterogeneous causes rather than a single mechanism. For instance, GPT-5 exhibits memory override, Claude-Opus-4.1 shows perception-memory competition, while Qwen variants suggest visual-processing limits. Our findings challenge single-cause views and motivate probing-based evaluation that measures both knowledge and sensitivity to controlled visual change. Data and code are available at https://sites.google.com/view/vi-probe/.